ADHD remains widely under-recognised among England’s middle‑aged and older population

Published today in The Lancet Regional Health Europe, the research suggests that despite a substantial increase in diagnosis rates over the past decade for children and adults, overall recorded diagnoses of attention deficit hyperactivity disorder (ADHD) in England are still lower than prevalence estimates.

In recent years, public understanding of ADHD - a neurodevelopmental condition that affects attention, impulse control and emotional regulation - has begun to shift. Historically viewed as a primarily childhood condition, it is now increasingly recognised as a lifelong one. Awareness of ADHD across the general population has also grown.

The downside to this increased visibility is the persistent misconception that ADHD is widely over-diagnosed. Dr Amber John (University of Liverpool, UCL), co-lead author of the study, clarifies, “What we actually see in the data is that despite a brief period of increased diagnosis – due to greater visibility – it is still not reaching the kind of level we would expect.”

In this study, additionally co-led by Prof Joshua Stott (UCL) and Dr Gavin Stewart (King’s College London), the researchers used data from more than 3.5 million people registered with GP practices in England in 2025 to estimate the proportion of people with a recorded ADHD diagnosis at this time. They then compared this with published estimates of ADHD prevalence in the general population.

The researchers also examined data from more than 42 million patients in England to study diagnostic trends in ADHD from 2000 to 2024.

The findings revealed that 1.19% of people in England had an ADHD diagnosis in their primary care record. When compared with published estimates of ADHD prevalence from international studies, recorded diagnosis rates were notably lower across all age groups – particularly in middle-aged and older adults. This suggests that many people have gone unrecognised.

Rates of new ADHD diagnoses increased markedly after 2020 across most age groups, with the highest rates observed in boys under 18 years old. Increases among adults in this period were particularly notable in women. In contrast, diagnosis rates among adults aged 65 and over remained consistently low throughout the study period.

Amber explains, “The low rates observed in older adults don’t necessarily mean that ADHD is uncommon in older age. Instead, they may reflect historical differences in recognition and access to diagnosis, particularly among generations who grew up before ADHD was widely recognised.”

A major benefit to accurately understanding the incidence of ADHD across the population is in ensuring that appropriate services are in place.

Prof Joshua Stott adds, “It is important that people are guided by the data.

“For nearly all age groups, while prevalence is still lower than expected in 2025, there was an increase in diagnoses of ADHD after 2020. Providers that support people with ADHD should take these changing diagnostic rates into account when planning services.”

A previous study that compared 30,029 adults across the UK with diagnosed ADHD and 300,390 participants without ADHD found that adults with ADHD have reduced life expectancies.

“People with high ADHD traits in midlife and older age tend to have increased rates of physical and mental health difficulties,” says Joshua. “Consequently, it is useful for services and clinicians to be aware that while many in this group don’t have diagnoses, they may well have extra needs.”

Study co-author Dr Georgia Pavlopoulou (Anna Freud Charity, UCL), explains, “A diagnosis can be life‑saving, opening access to support, preventing crisis, and reducing isolation. It can also bring clarity, lessen shame, and strengthen relationships. The findings suggest that people who fall outside traditional ADHD stereotypes - such as older adults, women, and minoritised ethnic groups - may be especially affected.

“To turn this evidence into action, we want to see services better resourced to provide culturally responsive, gender-informed and equitable support.”

Dr Angela Hind, Chief Executive of the Medical Research Foundation, says, “ADHD can profoundly affect many aspects of a person’s life – education, work, relationships – and it often co-exists with other neurodevelopmental conditions.

“When it goes undiagnosed or unsupported, people may spend years not understanding the challenges they face. We’re proud to support research that will help strengthen ADHD services and ensure more children and adults can get the recognition and help they need.”

Study limitations

The authors note that ADHD was identified using diagnosis and prescription codes recorded in primary care data. As with all studies using routine healthcare records, it is possible that some diagnoses may have been misclassified.

Additionally, the reference prevalence estimates used for comparison in this study are based on meta-analyses synthesising findings from studies with varied definitions for and assessments of ADHD. Estimates should therefore be viewed as benchmarks rather than precise estimates of true prevalence of ADHD in England.

The main analysis may slightly underestimate the true prevalence of recorded ADHD, because some diagnoses may not have been fully recorded.

See the full study here >>